Grant Application Form – Duchy Health Charity

Organisation Name *

Year of inception

Applicant name

User Password *

Applicant position within organisation

Applicant email address *

Applicant phone number

Project name

Is your project health and wellbeing related?

Project start date

Grant amount requested

Purpose of grant

How does your project/offer fit with NHS provision?

Anticipated project completion date

Have you applied to any other grant funders for support? (If yes, please state who)

Is there any other supporting information you would like to provide?

Please attach any other relevant documents you wish to share

Where did you hear about Duchy Health Charity?

If your application is successful would you be willing to be featured as a ‘case study’ on our website?

For Grant applications over £5,000: Please attach: • A full set of audited accounts for the last financial year • A copy of your organisation’s Safeguarding policy

Please confirm what level of DBS checks you carry out for relevant employees

Organisation type *

Organisation address

Website address

Links to social media pages

Number of paid staff

Number of volunteers

Annual turnover for the last financial year

Future aims and objectives of your organisation (max 300 words)

Brief history of your organisation and purpose (max 300 words)

Project aims and objectives (what the project will deliver?) (max 300 words)

Project success measures (how will you measure whether the project has been successful?) (max 300 words)

How will your project benefit the people of Cornwall?

Are there any other organisations offering the same or a similar service? If yes, please provide details

Will a grant from Duchy Health Charity help to leverage grant funding from elsewhere? If yes, please provide details